High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting
Article first published online: 1 DEC 2005
Tropical Medicine & International Health
Volume 10, Issue 12, pages 1242–1250, December 2005
How to Cite
Manzi, M., Zachariah, R., Teck, R., Buhendwa, L., Kazima, J., Bakali, E., Firmenich, P. and Humblet, P. (2005), High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting. Tropical Medicine & International Health, 10: 1242–1250. doi: 10.1111/j.1365-3156.2005.01526.x
- Issue published online: 1 DEC 2005
- Article first published online: 1 DEC 2005
- Voluntary counselling HIV-testing;
- prevention of mother-to-child HIV transmission;
Setting Thyolo District Hospital, rural Malawi.
Objectives In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering ‘opt-out’ voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district.
Design Cohort study.
Methods Review of routine antenatal, VCT and PMTCT registers.
Results Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95–97] were pre-test counselled, 2965 (95%, CI: 94–96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n = 646) was 358 (55%, CI: 51–59) by the 36-week antenatal visit, 440 (68%, CI: 64–71) by delivery, 450 (70%, CI: 66–73) by the first postnatal visit and 524 (81%, CI: 78–84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16–22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available.
Conclusions In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a ‘different way of acting’ if PMTCT is to be scaled up in our setting.